| NPI | 1801383955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MN 124000) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 21504) |
| Enumeration Date | 2018-04-15 |
| Last Update Date | 2018-10-12 |